gms | German Medical Science

Objective: Due to widespread tumor extension, surgical treatment of sphenoorbital meningiomas is often difficult and challenging. This may be especially the case in bilateral manifestation of the tumor. We present a surgical series of 22 patients with 24 tumors, who underwent surgical resection.

Method: All patients were operated through the pterional approach using microsurgical technique between April 2005 and July 2013. Tumors infiltrated the sphenoid wing, lateral orbital wall / roof and parts of the temporal base, which was resected according to individual tumor extension. Extradural optic canal decompression was perfomed in all cases. Clinical data were collected prospectively including preoperative medical history, radiological, operative and histological findings and follow-up records.

Results: Our series includes 18 women and 4 man with a mean age of 55,8 years (42-74 years). 20 patients (90,9%) presented with proptosis of the affected side. Visual impairment was present in 15 patients (68,2%). Near total tumor resection was achieved in 14 tumors (58,3%), subtotal resection in 6 tumors (25%) and partial resection in 4 tumor (16,7%). Proptosis improved in 86,4% of patients with preservation of visual function in 81,8%. There was no perioperative mortality. One patient had a postoperative intracerebral hemorrhage without any residual neurological deficit. The overall mean follow-up time was 36,3 months (4-84 months). Postoperative median Karnofsky scale was 90 (60-90) on follow-up. Radiological tumor recurrence was observed in 2 patients (9,1%) and 1 patient underwent surgical resection for a recurrent tumor 6 years after initial surgery.

Conclusions: Successful resection of sphenoorbital meningiomas requires extensive extra- and intradural surgery, which depends on the individual tumor extension in each patient. Extradural optic canal decompression enabled satisfactory improvement or preservation of visual function in the majority of patients.